Use of the posterior pericardium to cover the bronchial stump after right extrapleural pneumonectomy

Our plain-English summary of Use of the posterior pericardium to cover the bronchial stump after right extrapleural pneumonectomy, by M. de Perrot (The Annals of Thoracic Surgery, 2013).

The study

• Author: M. de Perrot
• Journal: The Annals of Thoracic Surgery
• Published: 2013;96(2):706-8
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Limited tissue is available to cover the bronchial stump after right extrapleural pneumonectomy for malignant pleural mesothelioma. After completing the resection, the pericardial reflection can be freed from the superior vena cava, the right pulmonary artery and veins, and the posterior wall of the pericardial sac between the transverse and oblique pericardial sinuses. The length and mobility from the posterior pericardium can then provide excellent coverage for the right bronchial stump. This technique has the advantage of being easy to perform and requiring limited time and dissection.

Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This was a short surgical technique article from the journal's "How to do it" section, not a study of asbestos exposure. The author, a thoracic surgeon at Toronto General Hospital, described a way to cover the stapled end (stump) of the right main bronchus after right extrapleural pneumonectomy. This is an operation for malignant pleural mesothelioma that removes the lung, the chest lining, the diaphragm and part of the pericardium (the sac around the heart). In the method, the back wall of the pericardium is freed so it can be stitched over the stump. The author reported using it in 28 consecutive patients, 21 of whom had first received radiation to that side of the chest as part of a prospective trial. In four patients there was not enough tissue, and other tissue flaps were used. In the other 24, the posterior pericardium alone covered the stump. One patient, who had received chemotherapy before surgery, died of pneumonia within 30 days. No bronchopleural fistula, a feared complication of this surgery, was observed over a median follow-up of 14 months. The author concluded the technique "appears to be a safe option."

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Surgical technique description ("How to do it" article) with the author's own experience in a consecutive series of patients
• Who was studied: 28 consecutive patients with malignant pleural mesothelioma undergoing right extrapleural pneumonectomy at Toronto General Hospital, Canada, over about 4 years. 21 of them had received induction hemithoracic radiation as part of a prospective trial approved by the institution's research ethics board.
• Exposure: Not addressed: the article describes a surgical procedure and does not discuss asbestos or other exposures
• Main results:
  • In 4 of the 28 patients, the posterior pericardium did not provide enough tissue, and the stump was covered instead with a thymic flap (2 patients), a pericardial flap (1) or an omental flap (1)
  • In the remaining 24 patients, the bronchial stump was covered by the posterior pericardium alone
  • One patient (reported as 4%), who had received chemotherapy before surgery, died from pneumonia within 30 days after surgery
  • No bronchopleural fistula was observed clinically or on bronchoscopy. None of the remaining patients developed one after a median follow-up of 14 months (range 1 to 48 months).
• The authors' conclusion: The author concluded that using the posterior pericardium is easily applicable in most patients undergoing right extrapleural pneumonectomy. The author also concluded that it appears to be a safe option for covering the bronchial stump, even in patients who receive induction hemithoracic radiation.

Topics

Medical terms in this study, explained in our Lexicon: Pericardium, Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma, Pericardial.

Related studies

• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)
• Extrapleural pneumonectomy for diffuse, malignant mesothelioma — M.J. DaValle, L.P. Faber, et al. (1986)
• The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients — M. Beshay, G. Carboni, et al. (2008)
• Meta-analysis of survival after pleurectomy decortication versus extrapleural pneumonectomy in mesothelioma — E. Taioli, A.S. Wolf, et al. (2015)
• Extrapleural pneumonectomy for early stage malignant pleural mesothelioma: a harmful procedure — O. Rena, C. Casadio (2012)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)

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